Provider Demographics
NPI:1356804710
Name:SOUTHSHORE URGENT CARE PLLC.
Entity type:Organization
Organization Name:SOUTHSHORE URGENT CARE PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IBRAHIM
Authorized Official - Middle Name:
Authorized Official - Last Name:DABAJA
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C, PHD
Authorized Official - Phone:734-444-2961
Mailing Address - Street 1:20789 GIBRALTAR RD
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48183-5087
Mailing Address - Country:US
Mailing Address - Phone:734-444-2961
Mailing Address - Fax:
Practice Address - Street 1:20789 GIBRALTAR RD
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN TWP
Practice Address - State:MI
Practice Address - Zip Code:48183-5087
Practice Address - Country:US
Practice Address - Phone:734-444-2961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-11
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care